Abstract
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Which country does not (now or in the near future) suffer from shortage of nurses? Nurse shortages are not only of this time and most of the time the shortages come and go. For the individual nurses a shortage sometimes leads to favourable situations on the personal level such as opportunities to easily change positions, the possibility to successfully negotiate job circumstances or the possibility to take a year leave to travel and afterwards come back to the same job.
However, at the level of daily work of nurses and quality of patient care, nurse shortages are not favourable. In earlier days it sometimes was stated that that adding extra nursing staff only would result in longer coffee breaks of nurses. However, recent publications lead to less humorous insights.
Researchers have tried to affirm what nurses always intuitively felt: the association between patient-to-nurse ratio and patient outcomes like patient mortality, complications and failure to rescue (death following complication) [1].
In a recent American study it was found that a higher proportion of hours of nursing care provided by registered nurses and a greater number of hours of care by registered nurses per day are associated with better care for hospitalised patients [2]. After analysing data of more than 5 million discharges of medical patients and over one million discharges of surgical patients they described that among medical patients a higher contact of hours of care per day provided by registered nurses were associated with a shorter length of stay, lower rates of infections and upper gastrointestinal bleeding. A higher proportion of hours of care was also associated with lower rates of pneumonia, shock or cardiac arrest and failure to rescue. Among surgical patients a higher proportion of care provided by registered nurses was associated with lower rates of infection and lower rates of failure to rescue. No association between increased levels of staffing and the rate of in-hospital death was found [2].
So if more hours of care by registered nurses per day is associated with better outcomes, the most obvious solution to improve outcomes seems to increase the number of nurses on a ward.
However, this is not so simple as it seems. Less young people are choosing nursing as a career or are quitting the job early. Tactics to attract nurses to the job involve big advertisements on public transportation and television. Educational programs are adapted to accommodate short versions of a nursing program or to combine work and education. In the US a tour with a video showing how valuable nurses are, recently started
At the same time the average age of working nurses increases much more than of other parts of the labour market [3]. Over the next two decades, this trend will lead to a further aging of the nursing workforce because the largest cohorts of nurses will be between age 50 and 69 years. Within the next 10 years, the average age of nurses in the United States is forecast to be 45.4 years, an increase of 3.5 years over the current age, with more than 40% of the nurses expected to be older than 50 years. The total number of nurses per capita is forecast to peak around the year 2007 and decline steadily thereafter as a lot of nurses retire. By the year 2020, the nursing workforce is forecast to be roughly the same size as it is today, declining nearly 20% below projected nurses workforce requirements. Considering the composition of the population in the rest of the world, comparable developments are expected in Europe and Australia. when the large baby-boom generation of nurses starts to retire [3].
The coronary care units like other ICUs have historically attracted younger nurses and the rapid decline in the number of nurses in the workforce under age 30 plays a large role in explaining the development of shortages in the ICU. Nowadays the hospitals also attract nurses that have lower education than professionally required [4].
In some countries higher educated nurses are hard to retain on the job since they often have to perform the same tasks (and receive the same salary) as nurses who had a lower education.
So in addition to attract young nurses to the profession, another challenge is to keep nurses motivated to stay in nursing?
In the area of cardiovascular nursing there are – although still limited – some areas that create some kind of career and provide opportunities for development for nurses.
In the last decade new roles for nurses emerged [5], giving nurses more independence, autonomy and opportunity to expand the profession of nursing. Examples are the role of nurses in cardiac rehabilitation, nurses in heart failure clinics or at the pacemaker clinic. In some home care settings there is room for specialization of nurses and in acute and chronic cardiac care settings nurse practitioners have several roles.
These new roles, however, need to be further consolidated by development of guidelines, curricula and by creating certified and acknowledged educational programs. The Working Group on cardiovascular nursing of the European Society of cardiology could (and should) play an important role in getting European standards of a cardiovascular nurse or cardiovascular nurse specialist.
In addition, research in the area of cardiovascular nursing is vital to strengthen the profession. In the search for evidence-based patient care we cannot do without scientifically sound and clinical (nursing) research.